Correct indication
When it may be appropriate
acceptable cartilage in the opposite compartment and no uncontrolled active inflammatory arthropathy.
- advanced symptomatic osteoarthritis predominantly confined to one tibiofemoral compartment
- pain that matches that compartment despite appropriate non-operative treatment
- functioning ligaments, a correctable deformity and adequate range of movement
Assessment
Imaging must confirm the pattern of wear
Weight-bearing radiographs are required, including views that assess the tibiofemoral and patellofemoral compartments and overall limb alignment. MRI does not replace these radiographs and is not routinely required in every case.
Anterior knee pain or patellofemoral change does not automatically rule out the operation. Severity, location and clinical correlation matter more than the mere presence of an imaging abnormality.
Potential advantages
What is preserved compared with total replacement
potentially less blood loss and tissue disruption.
- a smaller exposure, preservation of unaffected compartments and retained functional cruciate ligaments
- joint behaviour that may feel closer to the native knee and an often faster early recovery
Limitations
Why selection is crucial
Total knee replacement may be more appropriate when osteoarthritis is multicompartmental, deformity is fixed or the knee is unstable. After partial replacement, arthritis can progress elsewhere and the implant may loosen or require revision.
The decision is not based on age or body weight alone. Wear pattern, anatomy, activity level and expectations are central.
Alternatives
Total replacement and osteotomy answer different problems
Total knee replacement addresses disease affecting several compartments. Osteotomy redistributes load without replacing the joint and may suit an active patient with malalignment and a well-preserved opposite compartment.
The options should be compared using weight-bearing radiographs and a clinical assessment, not a single MRI image.
Recovery
Early mobilisation with criterion-based progression
Weight bearing is often allowed early with crutches when fixation and the clinical situation permit. Initial priorities are pain and swelling control, full extension, quadriceps activation and safe gait.
Low-impact activity is resumed progressively. Wound care, thromboprophylaxis, driving and work advice remain individual.